Provider Demographics
NPI:1639115959
Name:GONZALEZ MUNOZ, ANNMARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:GONZALEZ MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 6TH FLR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-793-9166
Mailing Address - Fax:401-444-2788
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 6TH FLR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-793-9166
Practice Address - Fax:401-444-2788
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010288207LP2900X
RI12851207LP2900X
RIMD12851207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021864326Medicaid
VT1008042Medicaid
RIMD12851OtherMEDICAL LICENSE
RIMD12851OtherMEDICAL LICENSE
VT1008042Medicaid